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STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION INSPECTION AND FINAL APPROVAL
APPLICANT: Jonathan and Alyssa Modine
AGENT: MIXON LAND SURVEYING, INC
PROPERTY ADDRESS: 17600 Pineapple Ln Fort Pierce, FL 34945
___�ICATION #:AP1163801
PERMIT #:56-SF-1566845
DOCUMENT #:FI1.012263
DATE PAID:10/23/2014
FEE PAID:515.0.0
RECEIPT #:56-PID-2559402
LOT:
SUBDIVISION:
BLOCK:
ID#: 2214-131.0002-000-0
Sit. Lucie Comb,
CHECKED [XI ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED.
TANK INSTALLATION
SETBACKS
[ ]
[011
TANK SIZE [11 1090.00 [21 483.00
[
1
[271
.SURFACE WATER 80
FT
[ 1
[021.
TANK MATERIAL Polyethylene
[
]
[281
DITCHES
FT
[ 1
[031
OUTLET DEVICE
I
]
[291
PRIVATE WELLS 80
FT
( 1.
1041
MULTI -CHAMBERED [ Y N ]
[
]
[301
PUBLIC WELLS
FT
[ ]
[051
OUTLET FILTER Polylok PL-68
[
1
[311
IRRIGATION WELLS
FT
[ 1
[061
LEGEND 1. 07-053-10 2. 70.143-54SC4
[
1
[321
.POTABLE WATER
FT
I 1
1071
WATERTIGHT
[
1
[331
BUILDING FOUNDATIONS 6
FT
I 1
[081
LEVEL
[
]
[341
PROPERTY LINES 70
FT
[ 1
[091
DEPTH TO LID
[
1
[351
OTHER
FT
DRAINFIELD INSTALLATION
FILLED / MOUND SYSTEM
( 1
[101
AREA [11 679.2 [21 SQFT
[
]
[363
DRAINFIELD COVER
[ 1
[111
DISTRIBUTION BOX HEADER X
[
1
[371
SHOULDERS
[ 1
[121
NUMBER OFDRAINLINES 1. 6.00 2.
[
1
(381
SLOPES
[ ]
[131
DRAINLINE -SEPARATION
[
]
[391
STABILIZATION 08/10/2015
[ 1
[141
DRAINLINE SLOPE
[ 1
1151
DEPTH OF COVER
ADDITIONAL INFORMATION
[ 1
[161
ELEVATION [ -ABOVE / BELOW ]BM 100
[
1
[401
UNOBSTRUCTED AREA
[ 1
[171
SYSTEM LOCATION
[
].
[411
STORMWATER RUNOFF
[ 1
1181
DOSING PUMPS
[
1
[421
ALARMS
[ 1
[191
AGGREGATE SIZE
[.
1.
[431
MAINTENANCE AGREEMENT
I 1
[201
AGGREGATE,EXCESSIVE FINES
[
1
[441
BUILDING AREA
[ 1
(211
AGGREGATE DEPTH.
I
]
[451
LOCATION CONFORMS WITH SITE PLAN
FILL
/ EXCAVATION MATERIAL
I
1
[461
FINAL SITE GRADING
[ 1
[221
FILL. AMOUNT
I
1
(471
CONTRACTOR MICHAEL W STUHR(ASHTO
[ 1
[231
FILL TEXTURE
I
1
[481
OTHER INFILTRATOR Quick4 Plus EQ36 LP
( 1
[241
EXCAVATION DEPTH
ABANDONMENT
[ 1
[251
AREA REPLACED
[
]
1491
TANK PUMPED
[ 1
[261
REPLACEMENT MATERIAL.
I
1
[501
TANK CRUSHED 6 FILLED
Comments: Comments are on page 2.
CONSTRUCTION L APPROVED / DISAPPROVED 1: 1
Eryl nmental Specialist
Klrchnar
FINAL SYSTEM [ AppgOVEp / DISAPPROVED ];
n nmen pec a s aco irc ner
(Explanation of Violations on following page)
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC
St. Lucie cHD DATE: 07/07/2015
St. Lucie CHD DATE: 08/10/2015
Page 2 of 3
EH Database v 1.0.1 AP1163801 EID1566045
� ^R
Comments
The system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow of
400 gpd.
System approved, contractor notified.
Final needed for mound and alarm.
Final approved with mounds stabilized, shoulders and slopes adequate.
Final emailed to contractor and building dept.
DH 4016, 08/09 (0bsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, PAC Page 2 of 3
EH Database v 1.0.1 pp1163801 EID1566645